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Sobieraj M, Urbanowicz T, Olasińska-Wiśniewska A, Gładki M, Michalak M, Filipiak KJ, Węclewska A, Bartkowska-Śniatkowska A, Tykarski A, Bobkowski W, Jemielity M. Anisocytosis as a possible predictor of low cardiac output syndrome in children undergoing mitral valve surgery. Adv Med Sci 2024; 69:147-152. [PMID: 38493878 DOI: 10.1016/j.advms.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/20/2023] [Accepted: 03/15/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE Mitral valve surgery in children involves correcting congenital and acquired pathologies, with a reported mortality rate of 0.9%. Low cardiac output syndrome (LCOS) is a serious complication with the incidence of 20-25%. The aim of the study was to estimate possible prognostic factors of LCOS in children undergoing mitral valve procedure. MATERIAL AND METHOD This single-center retrospective analysis enrolled children aged <18 years who underwent mitral valve surgery during 24 year period. Preoperative clinical and laboratory parameters, and operative factors were analyzed. RESULTS Thirty consecutive pediatric patients (11 (37%) males and 19 (63%) females) in median (Q1 - Q3) age of 57 (25-115) months, who underwent mitral valve replacement, were included. The 30-day mortality was 7% (2 patients) and was related to postoperative multiorgan failure. LCOS occurred in 8 (27%) children. The receiver operator curve (ROC) analysis established parameters that have predictive value for LCOS occurrence: cardiopulmonary bypass (CPB) time, with 89 min as optimal cut-off point (AUC = 0.744, p = 0.011) yielding sensitivity of 100% and specificity of 42.9%; left ventricular ejection fraction (LVEF) < 60 % (AUC = 0.824, okp = 0.001) with sensitivity of 62.5% and specificity of 93.75%; and red blood cell distribution width (RDW) above 14.5 % (AUC = 0.840, p < 0.001; sensitivity of 87.5% and specificity of 75%). CONCLUSIONS In mitral valve replacement in pediatric patients, CPBtime above 89 min, preoperative LVEF below 60% and preoperative RDW above 14.5% can be regarded as the potential predictors of LCOS.
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Affiliation(s)
- Michał Sobieraj
- Pediatric Cardiac Surgery Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Urbanowicz
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland.
| | - Anna Olasińska-Wiśniewska
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Gładki
- Pediatric Cardiac Surgery Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof J Filipiak
- Institute of Clinical Science, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland; Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Anita Węclewska
- Pediatric Cardiac Surgery Department, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Andrzej Tykarski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Waldemar Bobkowski
- Pediatric Cardiology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Jemielity
- Pediatric Cardiac Surgery Department, Poznan University of Medical Sciences, Poznan, Poland; Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, Poznan, Poland
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Manuel V, Miana LA, Guerreiro GP, Turquetto A, Santos RM, Fernandes N, Tenório DF, Caneo LF, Jatene FB, Jatene MB. Preoperative Neutrophil-Lymphocyte Ratio Can Predict Outcomes for Patients Undergoing Tetralogy of Fallot Repair. Braz J Cardiovasc Surg 2021; 36:607-613. [PMID: 34236799 PMCID: PMC8597611 DOI: 10.21470/1678-9741-2020-0408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/18/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Elevated neutrophil-lymphocyte ratio (NLR) has been associated with poorer outcomes in cyanotic patients undergoing single ventricle palliation. Little is known about this biomarker on patients with tetralogy of Fallot (TOF), the most common cyanotic congenital heart disease. Our objective is to study the impact of preoperative NLR on outcomes of TOF patients undergoing total repair. METHODS This retrospective study included 116 consecutive patients between January 2014 and December 2018. Preoperative NLR was measured from the last complete blood count test before the surgery. Using the cutoff value of 0.80, according to the receiver-operating characteristic (ROC) curve, the sample was divided into two groups (NLR < 0.80 and ≥ 0.80). The primary endpoint was hospital length of stay (LOS). RESULTS ROC curves showed that higher preoperative NLR was associated with longer hospital LOS, with an area under the curve of 0.801±0.040 (95% confidence interval 0.722 - 0.879; P<0.001). High preoperative NLR was also associated with long intensive care unit (ICU) LOS (P=0.035). Preoperative NLR predicted longer hospital LOS with a sensitivity of 63% and a specificity of 81.4%. CONCLUSION Higher preoperative NLR was associated with long ICU and hospital LOS in patients undergoing TOF repair.
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Affiliation(s)
- Valdano Manuel
- Division of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
| | - Leonardo A. Miana
- Division of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Gustavo Pampolha Guerreiro
- Division of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Aida Turquetto
- Division of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Rômullo Medeiros Santos
- Division of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Natália Fernandes
- Division of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Davi Freitas Tenório
- Division of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Luiz Fernando Caneo
- Division of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fabio B. Jatene
- Division of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Marcelo Biscegli Jatene
- Division of Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Wu X, Luo Q, Su Z, Li Y, Wang H, Yuan S, Yan F. Prognostic Value of Preoperative Absolute Lymphocyte Count in Children With Tetralogy of Fallot. J Am Heart Assoc 2021; 10:e019098. [PMID: 33998242 PMCID: PMC8483512 DOI: 10.1161/jaha.120.019098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Absolute lymphocyte count (ALC) is a low‐cost and easy‐to‐obtain inflammatory indicator; however, its association with the prognosis of patients with TOF remains unknown. This study aimed to determine the prognostic value of preoperative ALC in children with TOF. Methods and Results This retrospective study included 707 patients aged <6 years who underwent corrective operations for TOF between January 2016 and December 2018 in Fuwai Hospital, China. The end points were mortality, extracorporeal membrane oxygenation placement, postoperative hospital stay >30 days, and severe postoperative complications; patients were grouped on the basis of prognosis: poor prognosis (n=76) and good prognosis (n=631). Univariable and multivariable logistic regression analyses were performed to identify the independent risk factors for poor prognosis, on which a risk scoring system was based. The receiver operating characteristic curve was used to assess model performance. Using another model without ALC, the effect of the addition of ALC was assessed. Results suggested that ALC was an independent factor with a cutoff point of 4.36×109/L. The addition of ALC improved the area under the curve from 0.771 to 0.781 (P<0.001). To avoid reverse causality and further control for confounding factors, the patients were further divided on the basis of ALC level, and a propensity score matching was performed; 117 paired patients were identified for further analysis. Low ALC levels had an odds ratio of 3.500 (95% CI, 1.413–8.672). Conclusions Low preoperative ALC represents an independent predictor of poor prognosis in children with TOF.
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Affiliation(s)
- Xie Wu
- Department of Anesthesiology Fuwai HospitalNational Center of Cardiovascular DiseasesChinese Academy of Medical Sciences, and Peking Union Medical College Beijing China
| | - Qipeng Luo
- Department of Anesthesiology Fuwai HospitalNational Center of Cardiovascular DiseasesChinese Academy of Medical Sciences, and Peking Union Medical College Beijing China
| | - Zhanhao Su
- Center for Pediatric Cardiac Surgery Fuwai HospitalNational Center of Cardiovascular DiseasesChinese Academy of Medical Sciences, and Peking Union Medical College Beijing China
| | - Yinan Li
- Department of Anesthesiology Fuwai HospitalNational Center of Cardiovascular DiseasesChinese Academy of Medical Sciences, and Peking Union Medical College Beijing China
| | - Hongbai Wang
- Department of Anesthesiology Fuwai HospitalNational Center of Cardiovascular DiseasesChinese Academy of Medical Sciences, and Peking Union Medical College Beijing China
| | - Su Yuan
- Department of Anesthesiology Fuwai HospitalNational Center of Cardiovascular DiseasesChinese Academy of Medical Sciences, and Peking Union Medical College Beijing China
| | - Fuxia Yan
- Department of Anesthesiology Fuwai HospitalNational Center of Cardiovascular DiseasesChinese Academy of Medical Sciences, and Peking Union Medical College Beijing China
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Hoyos Mejía L, Romero Román A, Gil Barturen M, Córdoba Pelaez MDM, Campo-Cañaveral de la Cruz JL, Naranjo JM, Crolwey Carrasco S, Tanaka S, Sánchez Calle A, Varela de Ugarte A, Gómez de Antonio D. Thoracic surgery during the coronavirus disease 2019 (COVID-19) pandemic in Madrid, Spain: single-centre report. Eur J Cardiothorac Surg 2020; 58:991-996. [PMID: 33084869 PMCID: PMC7665479 DOI: 10.1093/ejcts/ezaa324] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES ![]()
We reviewed the incidence of coronavirus disease 2019 cases and the postoperative outcomes of patients who had thoracic surgery during the beginning and at the highest point of transmission in our community. METHODS We retrospectively reviewed patients who had undergone elective thoracic surgery from 12 February 2020 to 30 April 2020 and were symptomatic or tested positive for severe acute respiratory syndrome coronavirus 2 infection within 14 days after surgery, with a focus on their complications and potential deaths. RESULTS Out of 101 surgical procedures, including 57 primary oncological resections, 6 lung transplants and 18 emergency procedures, only 5 cases of coronavirus disease 2019 were identified, 3 in the immediate postoperative period and 2 as outpatients. All 5 patients had cancer; the median age was 64 years. The main virus-related symptom was fever (80%), and the median onset of coronavirus disease 2019 was 3 days. Although 80% of the patients who had positive test results for severe acute respiratory syndrome coronavirus 2 required in-hospital care, none of them were considered severe or critical and none died. CONCLUSIONS These results indicate that, in properly selected cases, with short preoperative in-hospital stays, strict isolation and infection control protocols, managed by a dedicated multidisciplinary team, a surgical procedure could be performed with a relatively low risk for the patient.
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Affiliation(s)
- Lucas Hoyos Mejía
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Alejandra Romero Román
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Mariana Gil Barturen
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Maria Del Mar Córdoba Pelaez
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - José Manuel Naranjo
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Silvana Crolwey Carrasco
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Shin Tanaka
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Alvaro Sánchez Calle
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Andrés Varela de Ugarte
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Gómez de Antonio
- Department of Thoracic Surgery and Lung Transplantation, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Clinical course of coronavirus disease 2019 in 11 patients after thoracic surgery and challenges in diagnosis. J Thorac Cardiovasc Surg 2020; 160:585-592.e2. [PMID: 32414594 PMCID: PMC7252193 DOI: 10.1016/j.jtcvs.2020.04.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To illustrate the clinical course and difficulties in early diagnosis of coronavirus disease 2019 (COVID-19) in patients after thoracic surgery. METHODS We retrospectively analyzed the clinical course of the first 11 patients diagnosed with COVID-19 after thoracic surgery in early January 2020. Postoperative clinical, laboratory, and radiologic records and the time line of clinical course were summarized. Potential prognostic factors were evaluated. RESULTS In the 11 confirmed cases (3 female, 8 male), median days from symptom onset to case detection was 8. Insidious symptom onset and misinterpreted postoperative changes on chest computed tomography (CT) resulted in delay in diagnosis. There were 3 fatalities due to respiratory failure, whereas 4 severe and 4 mild cases recovered and were discharged. All patients had once experienced leukocytosis and eosinopenia. Remittent fever and resected lung segments ≥5 were associated with fatality. CONCLUSIONS The case fatality rate of postsurgical patients subsequently diagnosed with COVID-19 was 27.3%. Insidious symptom onset, postoperative leukocytosis with lymphopenia, and postsurgical CT changes overshadowed the early signs of viral pneumonia. Dynamic symptom monitoring, serial chest CTs, and tests for viral RNA and serum antibody improve the chance for prompt detection of COVID-19. Consideration should be given to preadmission and preoperative screening and strict contact isolation during the postoperative period.
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6
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Alsoufi B. Preoperative cell line abnormalities in children with chronic cardiac disease: Symbol or surrogate? J Card Surg 2020; 35:524-525. [PMID: 31971289 DOI: 10.1111/jocs.14437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky
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7
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Jones SE, Jooste EH, Gottlieb EA, Schwartz J, Goswami D, Gautam NK, Benkwitz C, Downey LA, Guzzetta NA, Zabala L, Latham GJ, Faraoni D, Navaratnam M, Wise-Faberowski L, McDaniel M, Spurrier E, Machovec KA. Preoperative Laboratory Studies for Pediatric Cardiac Surgery Patients: A Multi-Institutional Perspective. Anesth Analg 2020; 128:1051-1054. [PMID: 30896598 DOI: 10.1213/ane.0000000000004114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Stephanie E Jones
- From the Department of Anesthesiology, Division of Pediatric Anesthesia, Duke University Medical Center, Durham, North Carolina
| | - Edmund H Jooste
- From the Department of Anesthesiology, Division of Pediatric Anesthesia, Duke University Medical Center, Durham, North Carolina
| | - Erin A Gottlieb
- Department of Anesthesiology, Perioperative, and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jamie Schwartz
- Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesia and Critical Care Medicine, Johns Hopkins Children's Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Dheeraj Goswami
- Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesia and Critical Care Medicine, Johns Hopkins Children's Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nischal K Gautam
- Department of Anesthesiology, Division of Pediatric Cardiothoracic Anesthesiology, The University of Texas Medical Center at Houston, Houston, Texas
| | - Claudia Benkwitz
- Department of Anesthesia and Perioperative Care, Division of Congenital Cardiac Anesthesia, University of California at San Francisco School of Medicine, San Francisco, California
| | - Laura A Downey
- Department of Anesthesiology, Division of Pediatric Cardiac Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Nina A Guzzetta
- Department of Anesthesiology, Division of Pediatric Cardiac Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Luis Zabala
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gregory J Latham
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - David Faraoni
- The Hospital for Sick Children, Department of Anesthesia and Pain Medicine, Division of Cardiac Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Manchula Navaratnam
- Lucile Packard Children's Hospital, Department of Anesthesiology, Perioperative and Pain Management, Division of Pediatric Anesthesia, Stanford University, Stanford, California
| | - Lisa Wise-Faberowski
- Lucile Packard Children's Hospital, Department of Anesthesiology, Perioperative and Pain Management, Division of Pediatric Anesthesia, Stanford University, Stanford, California
| | - Matthew McDaniel
- Department of Anesthesiology, Division of Pediatric Anesthesia, University of North Carolina, Chapel Hill, North Carolina
| | - Ellen Spurrier
- Department of Anesthesiology and Critical Care, Nemours/Alfred I duPont Hospital for Children, Wilmington, Delaware
| | - Kelly A Machovec
- From the Department of Anesthesiology, Division of Pediatric Anesthesia, Duke University Medical Center, Durham, North Carolina
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8
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Manuel V, Miana LA, Guerreiro GP, Tenório DF, Turquetto A, Penha JG, Massoti MR, Tanamati C, Junior APF, Caneo LF, Jatene FB, Jatene MB. Prognostic value of the preoperative neutrophil‐lymphocyte ratio in patients undergoing the bidirectional Glenn procedure. J Card Surg 2019; 35:328-334. [DOI: 10.1111/jocs.14381] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Valdano Manuel
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
- Cardio‐Thoracic CenterClínica GirassolLuanda Angola
| | - Leonardo A. Miana
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Gustavo P. Guerreiro
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Davi F. Tenório
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Aida Turquetto
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Juliano G. Penha
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Maria R. Massoti
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Carla Tanamati
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | | | - Luiz F. Caneo
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Fábio B. Jatene
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
| | - Marcelo B. Jatene
- Division of Cardiovascular SurgeryHeart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloPinheiros São Paulo Brazil
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Neutrophil–lymphocyte ratio as a mortality predictor for Norwood stage I operations. Gen Thorac Cardiovasc Surg 2019; 67:669-676. [DOI: 10.1007/s11748-019-01081-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/03/2019] [Indexed: 12/28/2022]
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